title: Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial.
abstract: OBJECTIVE
  To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.
  
  
  METHODS
  Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group.
  
  
  METHODS
  Rochester, New York.
  
  
  METHODS
  Children aged 3 to 10 years with persistent asthma.
  
  
  METHODS
  Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing.
  
  
  METHODS
  Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews.
  
  
  RESULTS
  We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference = 0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P < .01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk = 0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n = 285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference = 0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52).
  
  
  CONCLUSIONS
  The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
authors.forename: Jill S
authors.initials: JS
authors.lastname: Halterman
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Susan G
authors.initials: SG
authors.lastname: Fisher
authors.forename: Maria
authors.initials: M
authors.lastname: Fagnano
authors.forename: Paul
authors.initials: P
authors.lastname: Tremblay
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Conn
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.forename: Belinda
authors.initials: B
authors.lastname: Borrelli
mesh_terms: D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000032:analysis; D003376:Counseling; D023801:Directly Observed Therapy; D005260:Female; D000068298:Fluticasone; D006699:Home Care Services; D006801:Humans; D007202:Indicators and Reagents / Q000032:analysis; D036503:Inhalation Spacers; D016014:Linear Models; D008297:Male; D009518:New York; D012463:Saliva / Q000737:chemistry; D000068299:Salmeterol Xinafoate; D012572:School Health Services; D012621:Seasons; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D014505:Urban Population
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D007202:Indicators and Reagents; D014028:Tobacco Smoke Pollution; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D003367:Cotinine; D000420:Albuterol